Employee Type:

Regular

Work Shift:

Day - 8 hour shift (United States of America)

Join Team Tidelands and help people live better lives through better health!

Position Summary of Duties/Responsibilities :

1. Performs daily review of revenue integrity work queues to ensure departments are charging appropriately and revenue posted is correctly.

2.Provides guidance, communication and education on correct charge capture, coding and billing processes to clinical departments leaders and providers.

3.Analyzes business, clinical, and coding processes to identify possible inefficiencies and makes recommendations to improve procedures, prevent future losses and optimize reimbursement based on compliance standards.

4. Performs pricing reviews for hospital and professional billing. Maintain and update the Charge Description Master (CDM) to ensure it is accurate, complaint, and reflective of current clinical services and procedures.

5.Participate on performance improvement activities, including conducting routine charge capture reviews of revenue generating departments and implement any suggested changes once approved by Director of Reimbursement.

6.Perform data collection, tracking and analytical duties to respond to key issues to increase revenue integrity and process efficiency in support of the strategic initiatives and goals.

7.Work collaboratively with clinicians and revenue cycle teams to understand services provided, explore and capitalize on opportunities for enhanced revenue integrity, minimize charge leakage and maximize compliant reimbursement.

8.Performs pricing reviews for hospital and professional billing.

9.Investigate/research and advise on matters relating to professional/technical billing, coding, or regulatory requirements for documenting, coding, and billing. 10.Keeps abreast of changing industry requirements and regulations regarding acceptable documentation and billing practices by reviewing Federal Register, CMS, etc. Coordinates communication with the Director of Reimbursement regarding regulatory or payor changes to impacted leaders.

11.Contribute to departmental and organizational special projects as assigned; including but not limited to, price transparency, PAMA analysis, etc.)

QUALIFICATIONS

Education :

• Bachelor's Degree from an accredited college or university. Candidates without a bachelor’s degree will be considered with the following substitutes:

• High School Diploma or Associate Degree with seven years healthcare patient accounting experience required as noted below

Certification/Licensure :

• Certification in healthcare compliance (HCAA or AAPC's certification) and/or Coding Certification (RHIA, RHIT, CPC or CCS), preferred.

• Current and in good standing RN Licensure with South Carolina Board of Nursing, preferred

Preferred Qualifications:

•Experience in hospital charging/billing or performance charge review preferred

• Knowledge of CPT/HCPCS coding rules, Charge Master build/maintenance, Clinical charging practices, and billing regulations and practices.

• Experience with APC reimbursement, CMS rules and regulations, coding and billing compliance.

• Possesses working knowledge of various payment and coding systems, particularly IPPS, OPPS, HCPCS and CPT coding schemes.

• Experience working with EPIC HER

• Experience in multi-hospital organizations.

• Experience with Optum 360 CDM Master.

Experience :

• At least six years previous experience in a healthcare related setting with knowledge in charging and billing practices

• Must have advanced revenue code, CPT and HCPCS coding knowledge.

• Demonstrated ability to interpret, analyze, develop, direct and implement overall expectations as it relates to large scale implementations and projects.

• Excellent interpersonal and communication skills to positively interact with a variety of hospital personnel, including but not limited to administrative and management staff and resolve conflicts with tact and diplomacy.

• Ability to interface with all levels of the organization effectively Incorporating regulatory requirements and performing data input and analysis and QA.

• Highly skilled experience and knowledge of Windows-based software required, including but not limited to Microsoft Windows, Outlook and Excel.

• Possess effective oral and written skills, including superb formal presentation skills.

• Well-developed research skills.

• Excellent organizational and project management skills.

• Ability to identify and redesign inefficient workflow and processes.

• Proficiency with financial data with regards to charging, billing and reimbursement.

• Ability to analyze and interpret situations and information and offer guidance and quality decisions.

• Ability to perform work independently or with minimal supervision.

Physical Requirements : Light Physical Agility Test (PAT) Rating

While performing the duties of this job, the employee is frequently (activity or condition exists from 1/3 to 2/3 of the time) required to stand, sit, and walk; frequently to use hands, fingers; and frequently to talk or hear. The employee must exert up to 15 pounds of force occasionally (activity or condition exists up to 1/3 of the time), and/or up to 5 pounds of force frequently, and/or a negligible amount of force constantly to move objects.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

Tidelands Health is an equal opportunity employer (EOE). Tidelands Health does not discriminate against employees or applicants for employment on the basis of race, color, creed, religion, age, national origin, disability, marital status, veteran status, gender, genetic information, familial status, or any other legally protected status.